Dr.
The results have been anywhere from 94 to 240. This has happened 5 times. Been taking the tests for 7 months and these positive results have been happening for the past 6 weeks. Isabella County court has picked the place. It is called D' N' A at 210 Court Street, Suite G. Mount Pleasant Mi. 48858. We have been told the testing center/lab is in Kalamazoo Michigan.
This is makes no sense. No alcohol has been consumed. What could be causing this?

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Dr.
The results have been anywhere from 94 to 240. This has happened 5 times.... No alcohol has been consumed. What could be causing this?

The cut-off is too low. The lab is using a "no threshhold" test. This virtually guarantees this type of confusing and misleading result. The consistently low level return should serve to alert any professional involved in the process that the result is not derived from consumption. Likewise, these results should have been forwarded to a Medical Review Officer (MRO), that is a doctor experienced in addictions as well as testing methodology. Do you know if that occurred?

Where did the EtG come from? It came from a very low-level source of alcohol. Mouthwash, food, deodorant, and the list goes on into the thousands. Inhaled alcohol will create EtG. Hand cleansers were thoroughly investigated as they caused this same problem amongst doctors and nurses.

I'm very surprised that these low levels readings, particularly since they are consistently low, are being questioned. Does the person reviewing these results locally have any background in interpreting EtG?

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Dr. Please and thank you. Where can we find a qualified MRO? This has not occurred nor even mentioned. The Isabella County court has stated their cut off is 50 for the reults and are now convinced alcohol is being consumed. This is so far from the truth. It is very frustrating to be accused of something that is so FALSE. The lab sends the results back to the court house who reviews the information and passes their decisions. So in my opinion, no one is qualified. In fact it sounds as if they read a script from the internet when reviewing the test reults. Asked them today if an alcohol hair test going back 90 days would help prove to them and was told it is too new of testing and not submissable in court.

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If they're not already they soon will be flooded with people failing their test and the jails will be filled by hardened garlers. To give you a comparison, federally mandated tests (for transportation, etc) use a cut-off of 1000 for alcohol.

MROs are the final step in positive test results. That should have been done. Inquire and make certain. The MRO from the testing facility could explain to them as I have explained to you. That's his job.

Let me make certain you understand what I'm stating. 1) The test results are in all likelihood correct. 2) There was alcohol in his system. 3) The amount of EtG detected is so low that incidental exposure should be the top consideration. 4) It sounds as though there is a clerk or some naïve subject that hasn't a clue about how to properly assess the results. The results are right. It is the interpretation that is wrong.

They are right about the hair test, for alcohol. Few courts accept it. Began in 2008. Results spotty.

This is an all too common problem. My familiarity with it comes mostly from various nursing organizations representing their members that have been carelessly accused.

About the best I can do is to try to find some resources for information that might persuade someone to reconsider, leastwise put these test results in proper perspective. If you'll provide me with a city and state I'll try to find some medical resource, laboratory, etc. that could be of assistance. I'll do what I can but no guarantees. Is there a deadline, hearing, or action pending on the legal side of the issue?

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I really appreciate your feedback. I have been trying to find answers for weeks. We will definitely inquire about the MRO. There is no hearing at the moment. Only if another test results comes back positive. They have ordered daily testing now for three weeks and then another review. We live in Mount Pleasant, Michigan. This is a rather small town, so we are willing to travel, within the state of course.
He was never warned about products suchas household cleaners etc. And in the past 6 weeks he has been working on a project where epoxy and 99% rubbing alcohol is used. He has not worn gloves... wonder if this is the problem. Everything we investigated, stated alcohol needed to be consumed for positive results. No one at the court has even mentioned any other products, as the ones you mentioned, being any issued. Even if he inhaled these. Very interesting. This violation is now being considered for jail time.
Thank you so much for claifying. You are giving us some light in this devastating situation.
I look forward to hearing more from you.

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You may have struck the right chord. Alcohol used with epoxy is usually denatured alcohol not rubbing (isopropyl). Check that. Skin exposure and the inhalation of denatured alcohol could solve the puzzle, although I'll need to look up the composition.

ADDED: Denatured, as I thought, is ethanol. If that is what is being used on his project that is definitely the source of the problem. Plus, the time element matches.

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Would it still be a good idea to have a MRO ealuae this information. Because if it is the rubbing alcohol and epoxy, there are going to be more positive tests from the past week. And it should be evaluated about the levels to avoid jail time.

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First you need to verify the product being used at work. If it contains denatured alcohol that is noted on the label somewhere.

You are correct that he will continue to test low-level positive on a daily basis.

I am providing a link to a study conducted by Wurst, Skipper, etal demonstrating that ethanol hand gel creates a positive EtG marker. Wurst is the scientist that first discovered EtG as a bio-marker (1998) and Skipper introduced it in the US (2004). The study was published in Journal of Addiction Medicine, June 2009, and is available here.

Print copies of this and provide it to persons involved in this process.

Likewise, there is a website operated by Dr. Skipper that explains the proper interpretation of EtG results, here

No other person, doctor, toxicologist, can determine the source of the alcohol. They could only tell you what I have said.

It is difficult for me to imagine that a certified testing laboratory isn't having this process certified by an MRO. If it is being certified you would then have a beginning point, someone to contact, to clarify the readings. Please ask that specific question: Who is the Medical Review Officer in this case? Hope this gives you a start.

Keep me posted.

One further note. Dealing with these products, the employer should provide a respirator. Gloves and a canister respirator would probably end the problem, if I'm correct on the source. The majority of the ethanol is entering via inhalation. He's absorbing alcohol fumes.

Further note: I see that one lab is located in Mount Pleasant. Go to that location and request in writing that they provide 1. the name and address of the lab that did the test. This may, but shouldn't, require the subject to make the request due to medical confidentiality. 2. Provide them with a copy of the above study and advise them that they have made an error. 3. Request of them the identity of the MRO and the credentials, certifications for the testing lab they are using. Obtain their certification as well.

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DRBILL:
So VERY grateful for this information. I came across some of this, but not understanding it all. We will be looking into the MRO. But in the meantime, trying to figure out how to tell these'authority figures' they are wrong, is the challenge. Not sure how to go about this. Will keep you posted. And you are a guardian. Bless U

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The MRO should know what he's talking about. Back to the alcohol. Rubbing alcohol should say 70% isopropyl alcohol. That doesn't help. What other bottle are you referring to that says alcohol? Also, how did you find MRO

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We asked the testing center who the MRO is? They gave us a name, she owns the lab, Forensic Fluids out of Kalamazoo, MI.
The rubbing alcohol is 70% and the other products were Epoxy, afuel additive, and goo off. Using these products in an enclosed room with no gloves.

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